Provider Demographics
NPI:1922623750
Name:BOSTIAN, LINDSAY MIZOK (PA-S)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:MIZOK
Last Name:BOSTIAN
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:MISS
Other - First Name:LINDSAY
Other - Middle Name:LYNN
Other - Last Name:MIZOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-7726
Mailing Address - Country:US
Mailing Address - Phone:980-622-1969
Mailing Address - Fax:
Practice Address - Street 1:215 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-7726
Practice Address - Country:US
Practice Address - Phone:980-622-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant